Incredible Surgery Gives Man New Lease on Life

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Getting a kidney transplant is a big deal. Getting a pancreas
transplant is a big deal. But getting a kidney and a pancreas
transplant while simultaneously undergoing a scalp and skull
transplant — that was unheard of until very recently.

Last month, doctors in Texas performed the first-ever multi-organ
transplant paired with the transplant of a skull and scalp
tissue, according to MD Anderson Cancer Center. The patient —
James Boysen, a 55-year-old software developer from Austin, Texas
— was diagnosed with a rare cancer called leiomyosarcoma in 2006.
This cancer affected the muscles under his scalp, and although
doctors successfully
treated the disease with chemotherapy and radiation, Boysen
was left with a large, deep wound in both the skin and the bone
on top of his head.

In addition to needing surgery to repair his scalp and skull,
Boysen needed a new kidney and pancreas. Diagnosed with diabetes
at age 5, he had received kidney and pancreas transplants in
1992, but his doctors recently determined that he would again
need new organs. [ The
9 Most Interesting Transplants ]

However, Boysen's doctors were faced with a dilemma: The wound on
Boysen's head made a new transplant of his internal organs
impossible. A wound makes a patient
vulnerable to infection, said Dr. Jesse Selber, an associate
professor of plastic and reconstructive surgery at MD Anderson
Cancer Center in Houston and one of the surgeons who performed
Boysen's multiple transplants.

"A preexisting wound, especially one of that magnitude, is a
major risk for infection," Selber told Live Science. "There's a
general rule that if there's a major wound, you don't want to
perform a transplant."

But Boysen's doctors also feared that fixing the wound (by
performing reconstructive surgery on Boysen's head) would send
his already-weakened internal organs into a tailspin.

"It was a little bit of a catch-22. He was really of marginal
health status because he had two major organs failing, said
Selber, adding that a surgery to fix the wound could have
resulted in kidney
failure, which was a risk that Boysen was not willing to
take.

The doctors eventually made a decision about how to treat their
patient. Rather than treating the two issues (the scalp wound and
the failing organs) separately, they decided to combine all the
necessary transplants into one operation — a highly complicated
surgery using organs and tissues from a single donor, Selber
said.

More than 50 health care professionals were involved in the
procedure, which took 15 hours to complete. Boysen received two
new organs — a kidney and a pancreas — as well as the much-needed
skull bone and scalp tissue.

"The coordination of care was really complicated. We had to
coordinate multiple surgical teams from different hospitals doing
things we've never done before. And that, in and of itself, has
risks," Selber said.

Of course, there was also the risk that Boysen wouldn't survive
the surgery, but Selber said the patient is "sailing through" his
recovery. There's still a chance that Boysen could reject some of
his new parts, but Selber said doctors will continue monitoring
him carefully and adjusting his immunosuppressant medications as
needed to decrease the risk of that happening.